03 July 2013 3:51 PM

On the Mongering of Scares

I mentioned in my Mail on Sunday column last week that roughly half the measles cases reported in the recent Swansea outbreak (now apparently coming to an end, I’m glad to say) were actually confirmed by laboratory tests.

Since Public Health Wales qualified this by stating that for each recorded case there was another that went unrecorded, I felt obliged to report this too, even though a casual reader might think this lessened the impact of what I was saying.

Not that anyone followed it up anyway, or even commented upon it here, though it took some effort and persistence to obtain.

This fact about unrecorded cases (which I believe is confirmed by research) still seems to me to leave us with the conclusion that the outbreak was not as big as it at first seemed. I reproduce PHW’s entire statement below (right at the bottom of this posting) so that readers can judge for themselves. I have not yet had time to check with Public Health England on the cases from the Swansea area which they tested.

I knew when I posted this that the final Inquest would soon report on the death of Gareth Colfer-Williams, may he rest in peace, a Swansea man, much loved by his family, who sadly died at a very young age during the outbreak, apparently after contracting measles.

One of my critics on Twitter has already begun to squawk that I and others (who were sympathetic to parents worried about the MMR ) are in some way responsible for this regrettable death. I do not know, but will not be surprised, if certain journalists pursue the same 'scaremongering' line. I feel I am entitled and bound to defend myself against such attacks.

First, if we assume for the sake of argument that low MMR take-up can be blamed for the Swansea outbreak (a contention which cannot be discussed in the absence of comparisons and other facts) ; or that low MMR take-up in Swansea was caused in any way by media doubts about the safety of the injection (is there any actual evidence of this?) , I might say this:

I first wrote about the MMR in 2001, by which time Mr Colfer-Williams would have been 12 or 13 years old, so I could not have influenced his parents’ decision, whatever it may have been (see below). This was also a long time after the initial controversy, in which I played no part. From the start, I was concerned about the state of affairs in this country *after* the controversy had already gripped the public mind.

As for take-up in general, in Swansea or elsewhere, I have never advised my readers to refuse the MMR, nor stated that it was unsafe. I have urged (and continue to urge) official sympathy for parents worried about it, and said that they should have been allowed continued access to the single measles vaccine on their NHS for which they have paid in their taxes. I am persuaded that, had the authorities been more sympathetic, many more parents would have immunised their children against measles and so the danger of a measles outbreak in Swansea or anywhere else would have been much reduced. Given the choice between MMR and nothing, many chose nothing. This is how free people behave when they are bullied by authority, and if blame is being sought, then it lies with the bullies.

I have criticised politicians for using public money to urge others to use the MMR, while refusing to reveal if they have given it to their own children. I have reported, sympathetically, the personal concerns of Heather Edwards, the mother of Joshua Edwards. Joshua developed severe symptoms after both his MMR immunisations. I have criticised what I regard as the hounding of Andrew Wakefield, who raised the initial concerns about the vaccine. And I have complained about the exaggerated propaganda about the dangers of measles (some of it directed against me personally, in the form of a rather sinister fake letter) deployed by those who decry all doubt in this matter. Finally, while I do not in any way deny that measles can be dangerous in some circumstances, I continue to maintain that this danger is moderate in the case of healthy well-nourished people in good housing in advanced countries. The relevance of all or some of this should become clear in the account which follows.

It is, alas, impossible to discuss this matter without revealing some facts about the case which are bound to be distressing to Mr Williams’s family, to whom I offer my own sympathy for their sad loss. I very much regret the necessity, but do not see how I can defend myself otherwise. And I would point out that these facts have already been revealed in proper public proceedings in evidence, and have been published in newspapers in South Wales. I’ll first of all point out that , when in the past I have investigated claims that measles is a very dangerous disease, I have found that the deaths attributed to it have often not been as simple as first suggested. In the Dublin outbreak, often cited, one of those who died was suffering (shockingly in these times) from severe malnutrition. The other had a grave malformation of oesophagus and larynx. In the case of a more recent death in this country, the authorities refused to answer my questions on the deceased person’s general state of health, citing ‘confidentiality’ despite the fact that I had no interest in, not any intention of identifying him or her. There were strong unconfirmed suggestions that the deceased in that case was far from well before he contracted measles. I am simply unable to say if these were true or not, as the authorities at the time would not tell me, which I think is wrong in itself.

In this case, we have an inquest. The following facts emerged at this hearing, held in Swansea on Monday 1st July by the Coroner, Mr Philip Rogers. Mr Colfer-Williams is stated to have died from Giant Cell Pneumonia , a complication of measles, from which Mr Colfer-Williams was undoubtedly suffering when he died. The verdict was death from natural causes. While there is no evidence that Mr Colfer-Williams never received the MMR vaccine, that is of course not evidence that he did *not* ever receive it. He was 25, and so would be unlikely to remember having received it. And medical records from that far back are often incomplete or hard to find.

Mr Williams was not in good health at the time that he contracted measles. At the age of 25, he was 5 feet 9 inches tall, but weighed only seven stone seven pounds (105 lbs), which the coroner, Philip Rogers, described as ‘very underweight’ . A doctor has told me that a more normal weight for a man of this age and height would be eleven stone seven pounds (161 lbs). He suffered, according ot the coroner, from ‘alcohol problems’ or ‘addiction to alcohol’, for which he was undergoing ‘treatment’, said to have involved ‘antidepressant’ medication. The coroner said the drugs ‘were used to manage withdrawal and other symptoms’.

According to one account, (South Wales Evening Post 2nd July) , two weeks before his death he was ‘thought to have overdosed’ on Amitryptiline, a prescribed drug, an event which he survived, but which resulted in a hospital stay of some days. {My note: Wikipedia describes Amitryptiline as a tricyclic antidepressant, with effects similar to that of SSRIs. It also says it has a high rate of fatality in overdose}. But in the same story, and also in the Western Mail account, published the same day, it is said that the pathologist Dr Maurizio Brotto, stated ‘there was no question of an overdose’ as all the drugs were in the normal therapeutic range.

As far as I can discover through my own inquiries, the apparent contradiction arises because there was no question of an overdose *at the time of Mr Williams’s death*. The overdose was on an earlier, separate occasion. There were various prescription drugs in Mr Colfer-Williams's blood and urine at the time of death, but not in dangerous or non-therapeutic quantities.

After his earlier hospitalisation, Mr Williams was discharged with an alcohol detoxification programme, and it was after this that he went to his doctor complaining of an itchy rash (though this did not yet cover his whole body) together with cough and cold symptoms.

The Coroner, Philip Rogers, said that ‘there was a query of measles but also a possible reaction to one of the alcohol drugs, which he was told to stop. He was told to go home and take Paracetamol’.

{My note. I have not yet been able to find out which drug he was advised to stop taking.}

Mr Rogers continued : ’On April 18, his partner reported he had a high temperature and a rash all over his body and was suffering from what were described as hallucinations’. Soon afterwards, he died.

included the following statement from Dr Marion Lyons, Director of Health Protection at Public Health Wales.

"We are aware of the death of a man from measles, confirmed by the Swansea Coroner today. My sympathies are with the family at such a tragic time.

"Measles is a potentially fatal disease and around one in every 1,000 people who contracts measles in developed countries will die.

"Those not fully vaccinated with two doses of MMR are still highly likely to catch measles if they come into contact with an infected person as it is an extremely contagious disease.

"Although the outbreak has slowed down considerably in recent weeks, anyone who has not had two doses of the MMR is still unprotected.

“Symptoms of measles include fever, cold-like symptoms, fatigue, conjunctivitis and a distinctive red-brown rash that appears a few days into the illness.

"Anyone who thinks they or their child may have measles should speak to their GP immediately.”’

The BBC report also stated (relevant to the facts displayed above) ‘The inquest heard that Mr Colfer-Williams had suffered from alcohol problems and just two weeks before his death he had gone into detox leaving his body vulnerable to infection.’

**

Here, as mentioned above, is the official statement referred to above, about the level of confirmation of reported cases.

Between the beginning of March 2013 and 16 June 2013, the Public Health Wales microbiology laboratory in Cardiff tested 689 suspected measles cases from the outbreak area.

Of these, 318 were positive for measles, giving a positivity rate of 46 per cent for the whole of the period. During the peak of the outbreak in March 2013, the positivity rate was 53 per cent. This is in line with the expected positivity rate based on other measles outbreaks, where around 50 per cent of tested cases will be positive for measles.

This figure is only for cases tested in Cardiff, and does not include measles cases from Wales tested at the Public Health England laboratory in London, which carries out all measles testing outside of outbreak periods.

Measles cases reported in the current outbreak are notified cases and not laboratory confirmed cases. Notified cases are those reported to Public Health Wales by health professionals who are satisfied that a patient has the clinical symptoms of measles, and all suspected cases of measles must be reported to us by law as measles is a notifiable disease.

The notified cases figure for the outbreak area has now reached 1,202 between 1 November 2012 and 16 June 2013. It is important to note that not all of these cases will have been laboratory tested as it is not normal procedure to test all possible cases that have strong links to other cases. Cases that test negative will not be removed from the notified case total unless Public Health Wales believes it does not match the case definition used to determine what constitutes a case of measles linked to the outbreak. Measles testing is not 100 per cent accurate and so cases that test negative cannot always be denotified because they have tested negative if there are other reasons to believe the patient has measles.

We know that for every patient with measles who seeks medical advice and tests positive for measles, there will be at least one other person in the community who has measles but does not see a health professional. For that reason we can be confident that even if only half of our notified cases have tested positive for measles, the publicised number of notified cases still gives an accurate picture of the burden of measles in Wales during the outbreak.

It is important to note that Public Health Wales’s primary reason for collecting statistics on infectious disease is for purposes of surveillance – to know the burden of disease in Wales and to identify trends – and that it is impossible to accurately measure the precise number of patients with any infectious disease at any given time.

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Quick question, did your God design Measels as a punishment? Or was it a flaw in design (worrying for a designer to make such a flaw). Or was it our own fault as fallen creatures? Either way, what a lovely god.

I agree with your point (but not that it's the only point) that it is impossible to argue on Twitter. So another point would be, why do some people persist in trying to make it look like they are doing that but refuse to do so here where it's much easier? Maybe they believe they are in fact actually arguing, I don't know. But it seems strange to me that if they are so confident in being able to argue their views, they choose a place where it's impossible to do so instead of a place where it is, despite numerous invitations. I guess it's a lot easier to resort to cheap, tacky, dishonest and nonsensical comments instead of thought out views. Or maybe there is an agenda?

You may have read PHs latest article 'A response to Mr Charles'. The 'Mr Charles' describes people who may agree or have similar views to PH as 'myrmidons'. This is a very odd description to use. I am not (according to the Oxford English dictionary definition) either a 'hired ruffian' or 'menial servant' of anyone else's views. Neither is anyone else who has similar views. I wonder what could make them think such a thing? Or whether they actually do think it, or whether it's a reflection of some kind of agenda they are following? If so, 'myrmidons would be an accurate description of them.

On a similar note, earlier today I read some comments from people on the Andrew Wakefield case. I was shocked to discover the following: the journalist who wrote the Sunday Times article which led to Wakefield being struck off by the GMC was directly answerable to James Murdoch of News International, and that James Murdoch was an executive director on the board of Glaxo Smith Kline, one of the pharmaceutical companies which made the triple vaccine (not a lot of journalistic independence there!); that pharmaceutical companies pay bloggers to promote their products and discredit those who have concerns about them (e.g Wakefield) and other manipulative and criminal activities. Even the humble vitamin C has come under attack from drug companies in recent times who would prefer people to take their synthetic version instead of the real thing. It's truly frightening to consider the power and influence drug companies and the media, with their army of myrmidons, have over governments and in turn us - the powerless.

Sharispa writes: 'But as I'm sure you (PH) know, there will be those on Twitter who refuse to look at the facts and argue and try to blame you as being in some indirect way responsible for the poor man's death, ...'

I do not wish to argue with the points made by Sharispa but surely the point is that it is impossible to 'look at facts and argue' on Twitter. Had Neil Postman been alive to see its arrival, it would have confirmed everything he had to say about the modern world. Even this small point, not including the above quote, would have been cut off at the 'a' in 'arrival'.

The fact it didn't become a much larger contagion was purely luck. An open border policy means all sorts of lethal germs can and do enter. some rather exotic . Whilst not blaming immigrants for it all, modern travel would had it been common way back .bought the great plagues everywhere. We survived because communities tucked away in rural retreats never got contaminated.
So perhaps the Arrnegeddon all believers, believe is coming, will be just that. Over population, easy travel, no borders, and a might nasty virus immune to our western antibiotics

You have set out the circumstances of this sad situation very clearly and no one without an agenda could disagree with it. It is obvious from the medical evidence that this young man's death was not straightforwardly caused simply by measles and that there were underlying medical problems which contributed to it.

But as I'm sure you know, there will be those on Twitter who refuse to look at the facts and argue and try to blame you as being in some indirect way responsible for the poor man's death, just as the pro Cannabis people doggedly refuse to accept your invitation to debate the Cannabis issue here. I can't make out why they refuse to debate these things here where there is space, but persist in making cheap, trivial and nasty comments in 140 characters there. Perhaps it's a case of not actually being able to debate and not having anything worth saying, or perhaps they're simply twits who like to see their comments in electronic print. Or maybe both?

From what I know about the Wakefield case, it still seems to me that he was scapegoated and hounded out of his career on the most flimsiest and suspect evidence. As far as I am aware, Wakefield's findings have still not been definitively disproved. Yet his reputation and career have been permanently destroyed. If I had been faced with a choice between giving my child the MMR vaccine or nothing, I too would have chosen nothing. For a government to try and force parents to run possibly terrible risks on behalf of their children by withdrawing the single vaccine from them, is very close to dictatorship. Something not surprising in China, N. Korea etc, but not in a so-called 'democratic' and 'free' country. It shows clearly we are no where near as free as we think we are. It is the people who made up the government of the day who should be brought before the media spotlight and made to feel thoroughly ashamed of their despicable and dictatorial actions of the time, and who in large part, created the conditions which eventually led to this sad death. At the very least, they should be hauled before a public enquiry and made to answer for their criminal decisions.

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